Lighthouses of Australia Inc. Membership Application
Lighthouses of Australia Inc.
PO Box 4734
KNOX VIC 3152 Australia
ABN 80 892 357 539
keeper@lighthouse.net.au
www.lighthouse.net.au

Joining Lighthouses of Australia Inc. online is a simple three step process.

1. Complete the Personal Details screen
 2. Let us know how you can help LoA and choose the Membership Category that best suits your circumstances
3. Select your preferred payment method.

For Membership Assistance Call +613 9801 5427

1 - PERSONAL DETAILS

* Denotes mandatory field

Email Address: * (Your email address will be your unique identifier with LoA)
   
Company: (If required)
Title: *
First Name: *
Surname: *
Unit No./House Name :
Street/Road:
Suburb/City:   State:   Postcode/ZIP:
Country: *
Telephone No: eg (07) 3345 9999
Bus/Fax No: eg (07) 3345 1111
Mobile: eg 0411 999 999
Preferred Contact Method: *
Birthday List Details:    Day       Month       Year      ( Enter full year details eg 1952 )



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